Neonatal Health and Long-Term Outcomes: Twin-Based Evidence From Linked Scandinavian Registers

Evelina Bjorkegren, Bütikofer, Aline (), Gabriella Conti (), Marten Palme and Kjell Salvanes ()
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Evelina Bjorkegren: Stockholm University
Bütikofer, Aline: Norwegian School of Economics
Gabriella Conti: University College London
Marten Palme: Stockholm University
Kjell Salvanes: Norwegian School of Economics

No 18897, IZA Discussion Papers from IZA Network @ LISER

Abstract: This study examines the long-term consequences of neonatal health using three birth measures — weight, length, and head circumference. Using linked Swedish and Norwegian population registers with follow-up into adulthood, we compare birth measures of singletons and twins, and find that different birth measures capture distinct aspects of fetal development with varying predictive validity across outcoms. Birth length emerges as the strongest predictor of health outcomes, consistent with its role as a cumulative indicator of skeletal growth throughout gestation. Birth weight retains stronger associations with cognitive and educational outcomes (grade point average [GPA], years of schooling). Head circumference shows weak and inconsistent associations across specifications. Using within-pair head circumference differences to classify twins as symmetrically versus asymmetrically growth restricted, we find that symmetric intrauterine growth restriction is associated with substantially worse long-term outcomes than asymmetric restriction. We also document significant intergenerational transmission of birth anthropometrics. Exclusive reliance on birth weight may obscure important information about early developmental insults.

Keywords: birth weight; birth length; head circumference; twin studies; fetal origins; intrauterine growth restriction; linkage to administrative data (search for similar items in EconPapers)
JEL-codes: I12 I14 J13 J24 (search for similar items in EconPapers)
Date: 2026-08
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